Carl Sagan’s Baloney Detection Kit and the Birth of “Addiction Medicine” as a New Discipline: The Need for an in Utero Diagnostic Assessment Prior to Delivery

3b67f56268909f1dfa2a168a352ad09a“One of the saddest lessons of history is this: If we’ve been bamboozled long enough, we tend to reject any evidence of the bamboozle. We’re no longer interested in finding out the truth. The bamboozle has captured us. It’s simply too painful to acknowledge, even to ourselves, that we’ve been taken. Once you give a charlatan power over you, you almost never get it back.”

― Carl Sagan, The Demon-Haunted World: Science as a Candle in the Dark


Carl Sagan devised a toolkit for nonsense-busting and critical thinking, which includes these nine rules:

  1. Wherever possible there must be independent confirmation of the “facts.”
  2. Encourage substantive debate on the evidence by knowledgeable proponents of all points of view.
  3. Arguments from authority carry little weight — “authorities” have made mistakes in the past. They will do so again in the future. Perhaps a better way to say it is that in science there are no authorities; at most, there are experts.2Q==
  4. Spin more than one hypothesis. If there’s something to be explained, think of all the different ways in which it could be explained. Then think of tests by which you might systematically disprove each of the alternatives. What survives, the hypothesis that resists disproof in this Darwinian selection among “multiple working hypotheses,” has a much better chance of being the right answer than if you had simply run with the first idea that caught your fancy.
  5. Try not to get overly attached to a hypothesis just because it’s yours. It’s only a way station in the pursuit of knowledge. Ask yourself why you like the idea. Compare it fairly with the alternatives. See if you can find reasons for rejecting it. If you don’t, others will.

  6. Quantify. If whatever it is you’re explaining has some measure, some numerical quantity attached to it, you’ll be much better able to discriminate among competing hypotheses. What is vague and qualitative is open to many explanations. Of course there are truths to be sought in the many qualitative issues we are obliged to confront, but finding them is more challenging.
  7. If there’s a chain of argument, every link in the chain must work (including the premise) — not just most of them.carli
  8. Occam’s Razor. This convenient rule-of-thumb urges us when faced with two hypotheses that explain the data equally well to choose the simpler.
  9. Always ask whether the hypothesis can be, at least in principle, falsified. Propositions that are untestable, unfalsifiable are not worth much. Consider the grand idea that our Universe and everything in it is just an elementary particle — an electron, say — in a much bigger Cosmos. But if we can never acquire information from outside our Universe, is not the idea incapable of disproof? You must be able to check assertions out. Inveterate skeptics must be given the chance to follow your reasoning, to duplicate your experiments and see if they get the same result.

Screen Shot 2015-05-10 at 1.21.52 AM

A November 2014 Viewpoint article in the Journal of the American Medical Association entitled Addiction Medicine: Birth of a new Discipline describes the need for “integration of addiction specialty physicians throughout the health care system” and how they plan to accomplish this. Citing the 2012 “National Survey on Drug Use and Health” findings that only 11% of Americans in need of treatment recevied it, the authors conclude that the number of addiction psychiatry diplomates (1139) is not meeting the country’s “overwhelming need for addiction specialists. To close this “addiction treatment gap” they propose “greatly expanding addiction physician specialists to include physicians from internal medicine and other specialties.”

Lax Standards

The American Society of Addiction Medicine (ASAM) only requires that you complete a residency — any residency, even dermatology or surgery — plus one year of work in the field and then 50 hours of “education.”  I took the test in 2010 and passed by a large margin without any preparation.

Screen Shot 2014-03-17 at 3.29.21 PM

Remarkably, I received my “diploma” in the mail without every meeting or speaking with anyone.   I simply paid the fee and took the test at one of the local testing centers.   This is concerning as my prior board certifications required accredited residency and training programs and were dependent on not only successfully completing those programs academically but on the reports of my superiors documentation of my character and integrity.  Screen Shot 2014-03-03 at 1.22.02 PM

With these lax standards, the ASAM have been able to create a legion of board certified addictions specialists – outnumbering psychiatrists in the field by 3 to 1.

Takeover of state Physician Health Programs (PHPs)

These ASAM “addiction experts” have become so numerous they have been able to take over almost all the state Physician Health Programs (PHPs). Their national association—the Federation of State Physician Health Programs (FSPHP)–has a stated goal of universal acceptance of the 12-step doctrine: lifelong abstinence, and spiritual recovery as the one and only treatment, as spelled out in the “PHP Blueprint.”

Very much like Straight, Inc in the 70s and 80s, they have cast a wide net with doctors to ensnare them in an endless loop of drug testing and rehab—whether the tests are fabricated or not. The doctors will enjoy no sympathy from the public, and complaining about it is deemed a sign of your “disease.”   Furthermore, ASAM recommends that physicians only be referred to “PHP approved” facilities.  

The medical directors of these facilities can all be found on this list of ”Like-Minded Docs.”  Surprisingly, many Like-Minded Docs were former addicts and alcoholics, some even with criminal backgrounds.  There are felons and even double-felons on the list.

It’s a rehab shell game. Heads I win tails you lose.

And the program is expanding. The organization that oversees the licensing for all medical doctors, the Federation of State Medical Boards, adopted a new policy and approved the concept of “potentially impairing illness” and the Orwellian notion of  “relapse without use.”

Signals for “impairment can be as benign as not having “complete accurate, and up-to-date patient medical records” according to Physician Health Services, the Massachusetts PHP.  Despite the overwhelming amount of paperwork physicians now have, incomplete or illegible records could be construed as a red flag, since as Associate Direct of PHS Judith Eaton notes “when something so necessary is not getting done, it is prudent to explore what else might be going on.” The question is, who is next?”

Not Just For Doctors, But for Everyone

Most of us are unaware of this quiet operation to police and punish our private choices. This is the New Inquisition: a move to expand this program to virtually all professions, all Americans. They want to replace the system currently being used in pilots, bus drivers, and Federal Employees with “comprehensive drug and alcohol testing” that consists of the Laboratory Developed Tests (LDTs) they introduced. Their goal is 24/7 sobriety with complete abstinence, and zero tolerance using tests of unverified validity and unknown reliability.

And they have an implementation plan.  The American Society of Addiction Medicine (ASAM), bolstered by billions of dollars from forced rehab and mandatory drug testing, has a long reach and powerful political friends. ASAM plans to force your physicians to collect your urine in the name of preventive care.

That’s right, that free preventive care you’re getting under Obamacare might soon come packaged with drug screening, as outlined in the ASAM White Paper on Drug Testing.  . Drug testing, they say, is  “vastly underutilized” throughout healthcare. The White Paper—which is well worth reading—describes the use of drug testing “within the practice of medicine and, beyond that, broadly within American Society.”

No matter your profession, if you come for a check up, you may be unwittingly looped into being referred for  “assessment” and “treatment” in a “PHP-approved” facility, where to get free, among other things, you will have to admit you are powerless and surrender to God.

If we don’t start pushing back now, soon there will be mandatory drug testing for every citizen..  A good case can be made for forced drug testing for virtually every profession –a few well-placed opeds in The New York Times and pretty soon we’ll begin to think it’s reasonable to test teachers, food handlers, you name it. They are even recruiting pediatricians to test children.      And in the new system they will not have to change your test from “forensic” to “clinical.”   A doctor-patient relationship renders the test “clinical” and by having doctors collect these specimens and calling the consequences “treatment” they can successfully use these unverified and unregulated tests introduced and marketed through a loophole into mainstream medical practice through a loophole.

One of the major goals of ASAM is recognition by the American Board of Medical Specialties. Should this occur it will inevitably lead to the end of Addiction Psychiatry and, by outnumbering them 3:1 it will be enveloped into the all encompassing field of “addiction medicine.” “Who needs two specialties?” they will argue, especially since most medical experts have accepted that addiction is a chronic relapsing “brain” disease.

And this legion of “authority” will infest our hospitals and mainstream medicine where they will join hospital formulary, ethics, research and other committees where they will be able to outnumber and outvote those of open mind and critical thought just as they did in the PHP system and the field of medicine will then be subverted to the guiding philosophy of the “impaired physicians movement.”

Addiction is a serious problem and those afflicted with it need proper assessment, diagnosis and treatment.  This illegitimate and irrational authority does not provide that.  Having had a disease does not confer authority status–I have asthma but that does not make me an expert in reactive airway disease.    Neither does interest in something, no matter how sincere, make one an expert.  I’ve had a sincere interest in science since I was a child but did not claim to be an expert in science when I was 7 because I was a member of Sir Isaac Newton’s Scientific Club.   Aside from the $2200 I had to pay and sitting through the exam gaining  ABAM certification was not all that different. This is not “expertise.”

Screen Shot 2015-05-10 at 2.27.52 AM

Prior to accepting “addiction medicine” as an ABMS approved specialty their research, tenets and basic principles of should be subjected to critical reasoning and academic analysis of the Cochrane caliber to see if they are actually valid.  This includes their claims of remarkable success in treatment and the non-FdA approved laboratory developed tests (LDTs) that they introduce.d.    The authorities and experts involved in promoting the ideology, testing and treatment should  be subject to and Institute of Medicine (IOM) conflict of interest analysis.   Who is profiting? And all of the statements, claims and suppositions regarding addiction and the guiding philosophy of the group should be subjected to Carl Sagan’s Baloney Detection kit.   If this were done the results would be failure on all three counts. False premises lead to false constructs.

61141_121358938015778_1369375864_n

One thing is for certain. When society gives power of diagnosis and treatment to individuals within a group schooled in just one uncompromising model of addiction with the majority attributing their very own sobriety to that model, they will exercise that power to diagnose and treat anyone and everyone according to that model.

The birth of Addiction Medicine as an ABMS accepted discipline is sure to be a success for the LDT drug and alcohol testing and 12-step assessment and treatment industry, but its spawn is sure to be an inauspicious mark on the Profession and Guild of Medicine and a bane of society for years to come.images

Free Educational Webinar: How to Position Yourself as an EXPERT!

IMG_6274 2

The validity and reliability of opinions lie in their underlying methodology and evidence base. Reliance on the personal authority of any expert or group of experts is the fallacy of appeal to authority.

I have asthma but that does not make me a Pulmonologist.  That addiction “specialist” diagnosing and treating you may have 5 years prior been a proctologist; and maybe not even a very good one at that.

Somewhere there may be doctor with no post-graduate training in surgery wielding a scalpel and calling himself an expert surgeon, but it is difficult to imagine that he is a very good one.

http://disruptedphysician.com/2014/11/18/disrupted-physician-101-2-for-what-its-worth-appeal-to-authority-and-the-logical-fallacy-of-special-or-secret-knowledge/

 

Screen Shot 2014-12-30 at 1.12.01 AM

Addiction Medicine: The Birth of a New Discipline

Somehow, I don't think this is quite what they had in mind!

Ms (Leigh) Bella St John


“How to Position Yourself as an EXPERT, Make More Money and Help More People, by Becoming a Published Author – Even if You Don’t Know Where to Start!” Think about it – if you need to see a chiropractor, for example, would you rather see a general chiropractor, or one who has positioned …
http://leighstjohn.com/free-educational-webinar-how-to-position-yourself-as-an-expert/

View original post

Disrupted Physician 101.2: “Addiction Medicine” is a Self-Designated Practice Specialty Unrecognized by the American Board of Medical Specialties–(An AMA Census Term Indicating Neither Training nor Competence)

“Spirituality can go hand-in-hand with ruthless single-mindedness when the individual is convinced his cause is just”

Michela Wrong, In the Footsteps of Mr. Kurtz: Living on the Brink of Disaster in Mobutu’s Congo

Addiction Medicine: The Birth of a New Discipline

Addiction Medicine is currently not recognized by the American Board of Medical Specialties (ABMS).  It is still a a Self-Designated Practice Specialty and the American Board of Addiction Medicine is a Self-Designated Board.  So too is the American Academy of Ringside Medicine and Surgery, the American Academy of Bloodless Medicine and Surgery and the Council of Non-Board Certified Physicians.  But these Self-Designated Boards do not have the multi-billion dollar drug and alcohol testing and treatment industry supporting them. Addiction Medicine has deep pockets, and if the November 2014 issue of the Journal of the American Medical Association (JAMA) is a harbinger of what’s to come, this self-designated practice specialty currently being certified by a self-designated Board and bereft of anything resembling the educational and professional standards for quality practice in a particular medical specialty or subspecialty as defined by the ABMS, the American Council on Graduate Medical Education (ACGME) and the Institute of Medicine (IOM) may soon robber baron its way into acceptance by the Medical Profession.

One thing is for certain.  When society gives power of diagnosis and treatment to individuals within a group schooled in just one uncompromising model of addiction with the majority attributing their very own sobriety to that model, they will exercise that power to diagnose and treat anyone and everyone according to that model.  The birth of Addiction Medicine as an ABMS accepted discipline is sure to be a success for the drug and alcohol testing and 12-step treatment industry, but its spawn is sure to be an inauspicious mark on the Profession and Guild of Medicine and a bane of society for years to come.

cropped-jester

via Disrupted Physician 101.2: “Addiction Medicine” is a Self-Designated Practice Specialty Unrecognized by the American Board of Medical Specialties–(An AMA Census Term Indicating Neither Training nor Competence).

 

Disrupted Physician 101.2: “Addiction Medicine” is a Self-Designated Practice Specialty Unrecognized by the American Board of Medical Specialties–(An AMA Census Term Indicating Neither Training nor Competence)

V0011377 A quack doctor selling remedies from his caravan; satirizingEducational and Professional Standards in Medical Specialties and Subspecialties

The increasingly rapid growth and complexity of medical knowledge in twentieth century American medicine resulted in the creation of specialties and subspecialties.

A related development was the creation of “boards”  to “certify” physicians as  knowledgeable and competent in the specialties and subspecialties in which they claimed to have expertise.   The American Board of Ophthalmology, organized in 1917, was the first of these.

As the number of medical specialties proliferated an umbrella organization was formed to accomplish this task. The Advisory Board for Medical Specialties was created  in 1933 and reorganized as the American Board of Medical Specialties (ABMS) in 1970.  This non-profit organization oversees board certification of all physician specialists and sub-specialists in the United States.

The ABMS recognizes 24 medical specialties in which physicians can pursue additional training and education to pursue Board Certification.Screen Shot 2014-11-07 at 7.44.56 PM

In 1991 the American Board of Medical Genetics was approved as the 24th ABMS board and these 24 boards grant the  37 general certificates and 88 subspecialty certificates available to medical specialists today.

The ABMS Member Boards are responsible for developing and implementing the educational and professional standards for quality practice in a particular medical specialty or subspecialty and evaluate physician candidates for Board Certification.  They set the bar of knowledge and competence for their given area of expertise.

All of the ABMS Member Boards are:

“committed to the principle of examining doctors based on six general competencies designed to encompass quality care: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.”

These areas have been collectively identified by the ABMS, the American College of Graduate Medical Education (ACGME) and the Institute of Medicine (IOM) in order to standardize graduate medical education in any specialty  from medical school graduation through retirement.1

One of the  24 medical specialties ABMS recognizes in which physicians can pursue additional training and education and pursue Board Certification is Psychiatry.

Founded in 1934, The American Board of Psychiatry and Neurology (ABPN) is one of the 24 ABMS specialty boards. In 1959, the ABPN issued its first subspecialty certificate in Child and Adolescent Psychiatry and was the only ABNP subspecialty until 1991 when the first examination in Geriatric Psychiatry was administered.4 Addiction Psychiatry became a subspecialty of ABPN in 1993.

The ABPN governs the specialty of Psychiatry, of which Addiction Psychiatry is a subspecialty.   Board Certification in Addiction Psychiatry requires a four-year psychiatric-residency program for training in the prevention, diagnosis and treatment of mood, anxiety, substance-abuse as well as other psychological and interpersonal problems followed by an additional year of training in one of the 40 accredited Addiction Psychiatry Fellowship programs. The Accreditation Council for Graduate Medical Education (ACGME) is the professional organization responsible for the accreditation residency education programs in the US for ABMS specialty and subspecialty areas of medicine. Addiction Psychiatry training programs are governed by the ACGME and graduates are eligible for ABPN Certification in Addiction Psychiatry.

When this rigorous education and training is complete a candidate is Board Eligible and can then take the subspecialty certification exam. The exam assesses competency in the dand consultation, pharmacotherapy, pharmacology of drugs, psychosocial treatment and behavioral basis of practice to be Board Certified in the subspecialty of Addiction Psychiatry by the ABPN.

Candidates must then be assessed in  a number of areas including psychiatric evaluation and consultation, pharmacotherapy, pharmacology, toxicology, psychosocial treatment, behavioral basis of practice, and many other areas in which for the past half-decade they where taught and apprenticed.

The current structure of residency training is little changed from when it was conceived originally by William Stewart Halsted in the late 19th Century.  Physicians acquire knowledge and skills necessary to safely and competently manage patients through apprenticeship. Training in a specialty area provides a comprehensive platform that allows medical school graduates to apply a body of knowledge to patient care and the treatment of disease. This forms the foundation of our Guild–undifferentiated and general but pluripotential.

The American Academy of Addiction Psychiatry (AAAP) is the only professional organization in the US focused on the subspecialty of Addiction Psychiatry.   The AAAP Mission Statements are to: 2

  • Promote high quality evidence-based screening, assessment and treatment for substance use and co-occurring mental disorders.
  • Translate and disseminate evidence-based research to clinical practice and public policy.
  • Strengthen Addiction Psychiatry specialty training and foster careers in Addiction Psychiatry.
  • Provide evidence-based addiction education to health care trainees and health professionals to enhance patient care and promote recovery.
  • Educate the public and influence public policy for the safe and humane treatment of those with substance use disorders.
  • Promote prevention and enhance addiction treatment and recovery across the life span.
  • Promote research on the etiology, prevention, identification and treatment of substance use and related disorders.

Self-Designated Practice Specialty :  An AMA Census Term Indicating What a Group of Doctors are Calling Themselves.

Screen Shot 2014-03-18 at 5.22.16 PMThe American Medical Association records a physician’s Self-Designated Practice Specialty (SDPS) in response to an annual credentialing survey. According to the AMA, SDPS are “historically related to the record-keeping needs of the American Medical Association and do not imply ‘recognition’ or ‘endorsement’ of any field of medical practice by the Association. SDPS refers to a self-designated specialty and this is not equivalent nor does it imply ABMS [American Board of Medical Specialties] Board Certification.a_meissen_group_of_harlequin_and_the_quack_doctor_circa_1741_faint_blu_d5585085_001h

“The fact that a physician chooses to designate a given specialty/area of practice on our records does not necessarily mean that the physician has been trained or has special competence to practice the SDPS.”3

Physicians have been able to list addiction medicine as a self-designated area of practice using the specialty code “ADM” since 1990.Screen Shot 2014-11-07 at 7.45.43 PM

In contrast to these accepted board credentials, American Board of Addiction Medicine (ABAM)  certification requires only a medical degree, a valid license to practice medicine, completion of a residency training in ANY specialty, and one year‘s full time involvement plus 50 additional hours of medical education in the field of alcoholism and other drug dependencies. The majority of American Society of Addiction Medicine (ASAM) physicians meet these requirements by “working in a chemical dependency treatment facility, taking continuing medical education courses in addiction, or participating in research.”6

The American Society of Addiction Medicine’s mission is to “establishScreen Shot 2014-11-07 at 7.47.55 PM addiction medicine as a specialty recognized by professional organizations, governments,, physicians, purchasers, and consumers of health care products, and the general public.’5   They have succeeded in doing this as many consider them to be the experts in addiction medicine including regulatory agencies.

The goal of the American Board of Addiction Medicine (ABAM) Foundation is to “gain recognition of Addiction Medicine as a medical specialty by the American Board of Medical Specialties (ABMS).”

But Addiction Medicine is currently not recognized by the ABMS.  It is still a a Self-Designated Practice Specialty and the ABAM is a Self-Designated Board.  So too is the American Academy of Ringside Medicine and Surgery, the American Academy of Bloodless Medicine and Surgery and the Council of Non-Board Certified Physicians.   But these Self-Designated Boards do not have the multi-billion dollar drug and alcohol testing and treatment industry supporting them. Addiction Medicine has deep pockets, and if the November 2014 issue of the Journal of the American Medical Association (JAMA) is a harbinger of what’s to come, this self-designated practice specialty currently being certified by a self-designated Board and bereft of anything resembling the the educational and professional standards for quality practice in a particular medical specialty or subspecialty may soon robber baron its way into acceptance by the American Board of Medical Specialties.

Screen Shot 2014-11-23 at 11.15.15 PM

One thing is for certain.  When society gives power of diagnosis and treatment to individuals within a group schooled in just one uncompromising model of addiction with the majority attributing their very own sobriety to that model, they will exercise that power to diagnose and treat anyone and everyone according to that model.  The birth of Addiction Medicine as an ABMS accepted discipline is sure to be a success for the drug and alcohol testing and 12-step treatment industry, but its spawn is sure to be an inauspicious mark on the Profession and Guild of Medicine and a bane of society for years to come.

cropped-jester

  1. Stevens RA. In: Stevens R, Rosenberg C, Burns L, eds. History and Health Policy in the United States: Putting the Past Back in: Rutgers University Press; 2006:49-83.
  2. American Association of Addiction Psychiatry Website http://www.aaap.org/about-aaap/mission-statement (accessed 4/2/2014).
  3. American Medical Association. List & Definitions of Self-Designated Practice Specialties. August 21, 2012 http://www.ama-assn.org/ama.
  4. Juul D, Scheiber SC, Kramer TA. Subspecialty certification by the American Board of Psychiatry and Neurology. Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry. Spring 2004;28(1):12-17.
  5. http://www.asam.org/about-us/mission-and-goals.
  6. Tontchev GV, Housel TR, Callahan JF, Kunz KB, Miller MM, Blondell RD. Specialized training on addictions for physicians in the United States. Substance abuse : official publication of the Association for Medical Education and Research in Substance Abuse. Apr 2011;32(2):84-92.